Unknown Individual – Sports Medicine (Orthopaedic Surgery) Physician, NPI 1225060155
Sports Medicine (Orthopaedic Surgery) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,187 ORTHOPEDIC SURGERY in TX
Provider Addresses for Unknown Individual
1651 W ROSEDALE ST STE 100
FORT WORTH, TX 761047437
Phone: (817) 930-2030
Fax: (817) 930-2031
Type: Mailing
Harris Parkway, Fort Worth, Tarrant County, Texas, 76132, United States
FORT WORTH, TX 761324265
Phone: (817) 433-3450
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-02-23
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20070223000140 | I | Orthopedic Surgery | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 21 | 11 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 12 | 12 | $0 |
| 29824 | Partial removal of collar bone at shoulder using an endoscope | 11 | 11 | $0 |
| 29826 | Shaving of part of shoulder bone and repair of ligament using an endoscope | 11 | 11 | $0 |
| 29827 | Repair of shoulder rotator cuff using an endoscope | 11 | 11 | $0 |
Insurance plans in this area (ZIP 76104)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | TX | |
| Internal Medicine | TX | |
| - | TX | |
| Nurse Practitioner | TX | |
| General Surgery, Colorectal Surgery (Proctology) | TX | |
| O P H T H A L M O L O G Y | TX | |
| Nurse Practitioner | TX | |
| - | TX | |
| - | TX | |
| Orthopedic Surgery | TX |
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